Throat Pain

Common causes of throat pain

Viral infections

Colds, flu, COVID-19 and other viruses cause about 85 to 95% of throat pain in adults. Clues: runny nose, cough, hoarse voice, red eyes, mouth ulcers, gradual onset. Pain peaks on days 2 to 3 and fades within a week.

Strep throat

Strep throat is a bacterial infection most common in children aged 5 to 15. Typical features: sudden pain, fever, swollen tonsils with white patches, tender neck glands, and no cough or runny nose. A rapid test confirms it.

Tonsillitis and mono

Tonsillitis is inflammation of the tonsils, from viruses or strep. Mononucleosis causes severe throat pain with very swollen tonsils, extreme tiredness and swollen glands in teenagers and young adults.

Acid reflux

Stomach acid reaching the throat (laryngopharyngeal reflux) causes burning, a raw feeling, frequent throat clearing, hoarseness and a sensation of a lump. It is often worse in the morning and after large or late meals. Heartburn may be absent. See acid reflux.

Postnasal drip, allergies and dry air

Mucus dripping down the back of the throat from allergies or sinusitis irritates it, especially overnight. Dry indoor air and mouth breathing cause morning throat pain that eases after drinking.

Irritants and strain

Smoking, vaping, alcohol, shouting, singing and long periods of talking strain the throat and vocal cords.

Throat pain on one side

Pain on just one side narrows the possibilities:

• Peritonsillar abscess: pus beside one tonsil. Severe pain, difficulty opening the mouth (trismus), muffled voice, drooling and fever. Needs drainage.
• Swollen lymph node on one side during an infection.
• Tonsil stones in one tonsil.
• Dental infection or wisdom tooth referring pain to the throat.
• Glossopharyngeal neuralgia: rare, brief, electric-shock pain in the throat and ear triggered by swallowing.
• Eagle syndrome: rare, from an elongated bone in the neck.
• Throat or tonsil cancer: persistent one-sided pain, often with ear pain on the same side, a neck lump or blood in saliva.

Throat pain when swallowing

Pain on swallowing is called odynophagia. Common causes are viral pharyngitis, strep, tonsillitis, mono and canker sores at the back of the mouth. Painful swallowing deeper behind the breastbone suggests esophagitis from reflux, pills that got stuck (doxycycline, NSAIDs, potassium), or infection such as thrush in people with weak immunity. A feeling that food sticks needs evaluation.

Throat pain and ear pain

The throat and ear share nerves, so throat pain often radiates to the ear. This is common with tonsillitis, peritonsillar abscess and strep. In an adult, persistent ear pain on one side with a normal ear exam and throat pain should be checked for throat cancer.

Less common but important causes

• Epiglottitis: severe throat pain, painful swallowing and fever, with a throat that may look surprisingly normal. Emergency.
• Subacute thyroiditis: painful, tender front of the neck after a viral illness, with fever and sometimes palpitations.
• Retropharyngeal abscess: neck pain, stiffness and fever, mostly in young children.
• Sexually transmitted infections: gonorrhea or herpes in the throat.
• Heart attack or angina: occasionally felt as throat or jaw tightness.
• Laryngeal cancer and other throat cancers: persistent pain, hoarseness, swallowing problems, weight loss.

How doctors find the cause

The doctor will look at the throat, tonsils, teeth and ears, feel the neck glands and thyroid, and check breathing. Tests may include a rapid strep test or throat culture, a mono blood test, COVID-19 or flu testing, and for persistent symptoms, a laryngoscopy (a thin camera through the nose to view the throat and voice box). Imaging is used for suspected abscess.

Throat pain relief

• Pain relievers: acetaminophen (paracetamol) or ibuprofen, following the label dose. No aspirin for children or teenagers.
• Fluids: warm tea, broth or cold drinks and ice pops, whichever feels better.
• Saltwater gargle: half a teaspoon of salt in a cup of warm water, for adults and older children.
• Honey in warm water, for anyone over 1 year. Never give honey to babies under 12 months.
• Lozenges and throat sprays: numbing lozenges help adults and older children. Avoid in young children because of choking risk.
• Humidifier at night, and breathe through your nose.
• Rest your voice.
• For reflux: avoid late meals, alcohol and caffeine; raise the head of the bed; acid-reducing medicines if needed.

Antibiotics help only bacterial infections such as strep. They do not speed up viral throat pain.

Frequently asked questions

What causes throat pain without fever?

Throat pain without fever is often caused by acid reflux, postnasal drip from allergies, dry air, mouth breathing at night, smoking or voice strain. Mild viral infections can also occur without fever. Pain lasting more than 3 weeks should be examined.

Why does my throat hurt on one side?

One-sided throat pain can come from a swollen lymph node, a tonsil stone, a tooth infection or a peritonsillar abscess. A rare nerve pain can also cause it. Severe pain with difficulty opening your mouth needs urgent care. One-sided pain lasting weeks should be checked by an ENT doctor.

When should I worry about throat pain?

Seek emergency care for trouble breathing, drooling, inability to swallow saliva, or a muffled voice. See a doctor promptly for high fever, severe one-sided pain, a neck lump, or pain lasting more than 3 weeks, especially if you smoke or drink heavily.

How long does throat pain last?

Viral throat pain usually improves within 5 to 7 days. Strep throat improves within 1 to 2 days of starting antibiotics. Mono can cause throat pain for 1 to 2 weeks. Pain from reflux or allergies persists until the cause is treated.

Can acid reflux cause throat pain?

Yes. Acid reaching the throat causes burning, rawness, throat clearing, hoarseness and a lump sensation, often worse in the morning. Many people with throat reflux do not have heartburn. Lifestyle changes and acid-reducing medicines usually help within weeks.